Flexible optical surgical instrument



J. M. MEW @,MW

FLmIBLE OPTICAL SURGICAL INSTRUMBMI Filed May 10 1961 4 Emma-Sheet E abaMarch 19, 1963 J. M. MEW

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man uw 1o. 1961 f4. l/ 7/ @n Nm mm n. No. E. vm, 2 AIT mv United States3,081,767 FLEXIBLE OPTICAL SURGICAL INSTRUMENT John H; Hert, Cresskill,NJ., assignor to American C `scope Makers, Inc., Pelham Manor, NY., acorporation of New York Filed May 10, 1961, Ser. No. 109,139

` 1,0 Claims. (Cl. 12S-6) This invention relates to a llexible surgicalinstrument and more particularly to one which permits visualization offormerly inaccessible portions of the bronchi of a patient.

tinuation-in-part, there is` set forth a flexible surgical instrument`whichvis particularly adapted for use in visualizing the ureter andportions of the kidney. My present invention is concerned with theproblem of permitting visualizationof4 hitherto inaccessible bronchi inthe lungs of a patient,

Hitherto, optical` surgical instruments have been provided forvisualizing through an optical instrument the upper lobe bronchi as wellas certain other portions of the'tracheal bronchial tree. Suchinstruments have left much to be desired particularly in that the areassusceptible ofvisualizationwere limted. In addition, it has long beendesired toreduce the amount of discomfort suffered by a patient duringthe carrying out of such procedures.

It is, therefore, a principal object of the present invention to providea` highly llexible surgical instrument which permitsvisualization ofhitherto inaccessible portions of the bronchi with a minimum degree ofdiscomfort tothe patient.

Another object is toprovide such an instrument having` a unique degreeof exibility which may be readily manipulated by'the surgeon so that itmay be inserted and di-rectedinto any ofthe bronchi to whatever depthmay be required.`

A further object is to provide such an instrument which isextremelycompact and which is so constructed and arranged as to eliminateentirely the danger of a part of the instrument accidentally becomingdetached in the body of a patient.

Affurther object is to provide such an instrument by means of which`remote areas within the lungs of a patient may be illuminated by anelectrical, high intensity light source without requiring the need forinserting any electrical components into the body of a patient.

An important feature of the present invention relates to the provisionof a surgical instrument adapted for insertion through the mouth of apatient into the bronchus, having a relatively long tubular flexibleassembly connected at one end to` a viewing head assembly and at itsopposite'end to an eyepiece assembly. The interconnecting tubularassembly is flexible throughout its length but with the distal portionthereof having a greater degree of flexibility than the remainder. Meansare provided operable at the proximal end of the instrument fordeflecting the distal end of the instrument so that it may be directedinto a desired bronchus, the greater degree of flexibility of the distalportion of the elongated tubular assembly servingto concentrate thebending of the instrument `in the distal portion thereof.

In one embodiment of the present invention, a unitary,

connected to its distal end and the 3,3l,767 Patented Mar. 19, i963elongated flexible optical instrument is provided for in.- sertion intothe body of the patient. A composite flexible optical fiber bundleextends from end to end of an elongated llexible tubular assembly whichis joined at its distal end lo an objective or viewing head assembly.The proximal end of the elongated tubular assembly is joined to ahousing through which the image-conducting section of the fiber bundleextends into an eyepiece assembly provided for magnifying and focusingon to the eye of a viewer an image presented on the proximal end of theimage-conducting section. Means are provided in the housing forcontrolling and dellecting at will the distal end of the elongatedtubular assembly which carries the viewing head. Provision is also madefor introducing oxygen into the housing which passes along the tubularassembly to outlets located in relation to the length of the `instrumentso that in use, the oxygen outlet may always be located above the branchpoint between the right and; left bronchi thereby insuring an oxygensupply to both` lungs.

In accordance with a further feature of the present invention, thecomposite light and image-conducting optical fiber bundle together withthe viewing head assembly eyepiece assembly connected to its proximalend are formed as a unitary` assembly adapted to be removably mounted inan elongated flexible tubular sheath constructed to provide the requiredsupply of oxygen to the lungs of the patient and also to affordindependent deflection of its own distal end and the viewing headassembly which projects there-ii from in use.

The foregoing as well as additional objects and advantages of thepresent invention will be apparent from the following description ofpreferred embodiments of` the present invention and the accompanyingdrawings in which FIGURE 1 is an elevational view on an exaggeratedscale of an instrument constructed in accordance with the presentinvention;

FIGURE 2 is a sectional view taken through the line .Ll-2 of FIGURE land drawn on an enlarged scale;

FIGURE 3 is a sectional view taken through the line 3 3 of FIGURE 1 anddrawn on a further enlarged scale;

FIGURE 4 is a sectional d-d of FIGURE 2;

FIGURE 5 is a sectional view on an enlarged scale taken through thc line5 5 of FIGURE I;

FIGURES 6 8 are elevational views showing respectively the sheath,optical assembly and obturator of a further embodiment of the presentinvention;

FIGURES 9 and l0 are longitudinal sectional views respectively of theeyepiece and objective end portions of the sheath of FIGURE 6 with theoptical assembly of FIGURE 7 mounted therein; and

FIGURE 1l is a sectional view taken through the lines l1l1 of FIGURE 9.

Referring now to FIGURES l-S of the drawing in detail, flexible surgicalinstrument 10 comprises an elongated, ilexiblc tubular assembly 1lconnected at its proximal end to a housing 12 carrying an eyepieceassembly 13 and connected at its viewing head assembly 1d.

The housing 12 is conveniently formed as an elongated rectangularenclosure one end of which is connected to a tubular member 15 which isin turn demountably connectcd to an adapter 16. The adapter 16 isprovided with an annular groove in which an O-ring 17 is positioned toprovide an airtight joint between the interior of the member l5 and theadapter. The adapter 16 termiview taken along the line distal end to anobjective `or nates in a sleeve 18 of reduced diameter for a purpose yetto be described.

As shown most clearly in FIGURE 4, a pair of blocks 19 and 20 areslideably supported in spaced relation in the housing 12. The slideblocks 19 and 20 along one side thereof each having elongated racks 21and 22 respectively connected thereto and extending in opposed relationso as to mesh with the opposite sides of a pinion 23. The pinion 23 iscarried on a shaft 24 which extends through an opening in the wall ofthe housing 12 and through an external collar 25 and has a control knob26 fixed thereto. Collar 25 seals the opening in the housing and isformed with an annular recess in which an O-ring 27 is positioned toprevent Ithe escape of oxygen from the housing along the shaft 24.

Each vof the slide blocks 19 and 20 is formed with a longitudinallyextending hole, a control wire 28 being anchored in the block 19 and acontrol wire 29 being anchored in the block 20. Rotation of knob 26clockwise as viewed in FIGURE 2 causes a corresponding rotation ofpinion 23 and slide block 19 together with the control wire 28 isshifted a corresponding distance to the right while at the same time,slide block 20 and control wire 29 are shifted a corresponding distanceto the left. It will be noted, as most clearly shown in FIGURE 2,housing 12 is substantially longer than the slide blocks 19 and 20 whichare there shown in their center or neutral position. As will be morefully pointed out hereinafter, the control wires 28 and 29 are connectedto the distal end of the flexible tubular assembly 11 so that the distalend portion of the assembly 11 is flexed vertically to carry the viewinghead assembly 14 upward or downward (as viewed in FIGURE 1) dependingupon whether the control wire 28 or 29 is retracted to the right.

Eyepiece assembly 13 comprises an elongated tubular member 30 connectedto the proximal end of housing 12 and having an externally threadedextension 31. An eyepiece rotor 32 carrying magnifying and focusinglenses 33 is in threaded engagement with the extension 31 and extends intelescoping relation over the tubular member 30, an O-ring 34 extendingin a recess about the tubular member 30 providing an air-tight jointwith the rotor 32.

A composite light and image-conducting bundle 3S extends through theadapter 16 into the tubular member 15. As shown, the composite light andimage-conducting bundle 35 comprises a large number of extremely fine,optical, light-conducting fibers arranged in an imageconducting group 36which is surrounded throughout the major portion of the bundle by asecond group of lightconducting fibers 37. The image-conducting iibers36 extend axially through the housing 12 into the tubular member 30where its proximal end carrying a collar 38 is clamped by means of setscrews 39.

The composite lightand image-conducting bundle 35 may be manufactured asdescribed in the co-pending application of Lawrence E. Curtiss, filedDecember 19, 1960, Serial No. 76,868. As thus manufactured, although itis only about .2 inch in diameter, the bundle 35 may comprise anextremely large number, 75,000 to 100,000 or more extremely tineglass-coated optical glass fibers which extend continuously from end toend of the bundle 35. Thus, the optical bers forming the imageconductinggroup 36 extend from the proximal end face 40 thereof to the distal endface 4l (FIGURE 3). Similarly, the optical fibers forming thelight-conducting group 37, which are arranged about the group 36, extendcontinuously between the opposite end faces 42 and 43. It will be notedthat, as shown in FIGURE 2, the

optical bers of the light-conducting group 37 are gathered together toform a rod-like extension 37a projecting through an opening formed inthe tubular member into arm 44 to which it is sealed as by a suitablecement to prevent leakage of oxygen. The arm 44 terminates in a femaleLuer lock connector 45 by means of which a flexible light conductor (notshown) may be connected thereto.

It may be noted that the proximal end face 40 of the image-conductinggroup and the rotor 32 of the eyepiece assembly are positioned so thatrotation of the latter serves to focus the image on the end face 40 tothe eye of the viewer.

For the purposes of the present invention, the flexible composite lightimage-conducting bundle 3S may be approximately two and one half feet inlength and is so highly flexible that rigidication is desirable tofacilitate insertion and manipulation of the instrument. In the presentinstance such rigidilication is advantageously achieved by means of twosets ot flexible spiral members which together extend from end to end ofthe flexible tubular assembly 11. One set of spiral members comprisesthree spirally wound members 45, 46 and 47 extending one within theother, the outer-most spiral member 45 being of substantially greaterthickness than the other two. These spiral members may be formed ofstainless steel or other suitable resilient material and are wound sothat the turns of each spiral member passes its neighbor at rightangles. The proximal end of the spiral members 4547 are anchoredtogether and to the inner surface of the sleeve 18 as shown in FIGURE 2.The distal ends of the spiral members 45-47 are also anchored togetherand are connected to the inner surface of a tapered collar 48 which alsofunctions as an oxygen outlet as will be more fully described hereinater.

The secondset of spiral members are similar in construction andarrangement to the first set. Thus, the three spiral members 49, 50 and51 are wound so as to pass each other orthogonally and the outermostspiral member 49 is thicker than the inner spiral members 50 and 51.However, it is to be noted that each o-f the spiral members 49, 50 and51 is thinner and substantially more exible than the correspondingspiral members 45-47 of the first set. The proximal ends of the spiralmembers 49-51 are anchored to the inside of the distal end of thetapered collar 48 while the distal ends of these spiral members areanchored within the proximal end of a tubular cover member 52 of theviewing head assembly 14. It may be noted that the cover tube 52, in thepresent embodiment, has outer and inner diameters of about .280 inch and.260 inch respectively and is short, less than one inch in length.

The tapered collar 48 has a plurality of apertures 53 formedtherethrough so that oxygen fed into a itting 54 (FIGURE l) mounted inthe tubular member 15 may emerge through the collar 48 and pass into thelungs of the patient undergoing treatment.

A flexible thin-walled tube 55 encloses the spiral members 45-47 and issealed at its proximal end to the exterior of the sleeve 18 while at itsdistal end it is sealed to the exterior of the proximal end of thecollar 48. The tube 55 may be formed of polyvinyl chloride or othersuitable material. A second tube 56 also formed of thin-walled polyvinylchloride encloses the spirals 49-51 and has its opposite ends cementedto the tapered collar 48 and the cover tube 52. The tubes 55 and 56serve to enclose and seal the two set spiral members and thus provide asheath for the tie taie tubular assembly 11 except for the centralapertured portion of the tapered collar 48.

At the distal end of the composite image and lightconducting bundle 35,the bers forming the imageconducting section 36 are separated from thefibers forming the light-conducting section 37 by the end of a tubularlens holder 57. The proximal end of the lens holder 57 is preferablytapered as indicated to form a feather edge 58. Lenses 59 mounted in theholder 57 serve to focus an image of the field under view onto the endface 41 of the image-conducting section 36. The optical fibers in theimage-conducting section are mutually oriented in the opposite end faces40 and 4l so that an imageformed on the end face 41 is faithfullyreproduced on the end face 40 where it is viewed through the eyepieceassembly 13.

A tubular member 60 formed of glass or other suitable material ismounted within the cover tube 52 concentrically about the lens holder`57. The end walls of the tubular member 60 are optically polished andone of its ends is juxtaposed in butting relation against the end face43 of the light-conducting section 37. Thus, light conducted along thelight-conducting section 37 enters one end of the tubular member 60 andleaves through the opposite end wall thereof to illuminate the lield ofview. In order to minimize light loss along the tubular member 60, itsinterior and exterior surfaces are coated with silver as indicated at61.

As has been indicated, the control wires 28 and 29 extend throughout thelength of the tubular assembly 11 and both are anchored at points 180apart to the distal ends of the set of spiral members formed by themembers 49-51. While the tubular assembly 11 is highly tlexiblethroughout its entire length, the outer spiral member 45 and 49 lin thetwo spiral sets have sutcient thickness so as to insure that the distalend of the llexible tubular assembly 11 is detlectcd when the controlwires 29 and 29 are operated.

The tubes 55 and 56 which form the outer sheath of the instrument areconnected in air-tight relation to the sleeve 18, collar 48 and covertube 52. Thus, oxygen fed into the instrument can only escape throughthe apertures 53 in the collar 48.

For use in examining the bronchi of a patient, the instrument isconnected to a high intensity light source by coupling to the end face42 of the light conductor 37, a tlexible light conductor which isexposed at its opposite end to a high intensity lamp. A source of oxygenis connected to the tting 54. The instrument may be directly introducedthrough the mouth of the patient into the trachea by controlling itscurvature through adjustment of the control knob 26. However, theinstrument is preferably inserted through an open shelf laryngoscope,such as a Lloyds. The laryngoscope is rst positioned in the usual Way inthe mouth of the patient and then the instrument is fed along the rampor open shelf of the laryngoscope down through the trachea of thepatient, oxygen beingl fed through the instrument as has been described.Progress of the`instrument may be observed through the eyepiece 13 whilethe distal end of the instrument that is forward of the tapered collar48 is controlled by the surgeon through the knob 26. Because of thegreater degree of tlexibility of the portion of the tubular assembly onthe distal side of the tapered collar 4d, a high degree of manipulationand control is made possible. Thus, by turning the control knob 26 inone direction or the other to retract either control wire 28 or 29 theviewing head assembly 14 is tipped so as to pass into the right or leftbronchus and then into the small bronchi which are to be examined. Thetapered collar dll is located along the left of the tubular assembly 11in such a position that it always remains above the branch point of theright and left bronchi thereby insuring that oxygen is led to both lungsduring the course of the examination.

When an even greater degree ofcontrol of the distal end of theinstrument is desired, it may be constructed as will now be 'describedin connection with FIGURES 6ll where, in order to avoid unnecessaryrepetition, parts similar to those already described in connection withFIGURES l-S, are designated by the same reference characters.

l An open-ended elongated flexible sheath 75 comprises two sets ofspiral members as was described in connection with elongated iicxibletubular assembly 11. As was described in connection with FIGURE 5, theadjacent ends of the two sets of spiral members 45-47 and t9-51 are xedto the opposite inner end portions of tapered `collar 48. At theirdistal ends, the spiral members L19-51 to slide blocks 29 and 21previously described in connection with FIGURE 2 and are similarlymounted for longitudinal displacement in the housing 79. Control wires2d and 29 are anchored respectively to the slide blocks dll and d1 whichmay be shifted in the housing 79 by rotating a control ltnob 132 linkedto the slide A blocks through pinion 93 and racks 84 and 85.

A third slide block d6 is also longitudinally displaceable in thehousing 79 and is shiftable along the housingV by means of a controlltnob 97 linked thereto through pinion tid and raclr 99. A third controlwire 90 is tixed to the slide block lid.

The control wires 29 and 29 extend through the length of the sheath andare connected to the distal end of the spiral members ll95ll. Thecontrol wire 90 also extends through the sheath 75 and is connected tothe toe portion of the detlector 7d. In uce the control knob d2 servesto shift the control wires 2li and 29 and thereby deflect the distal endof the sheath 75 as was previously described in connection with theinstrument Il). Rotation of the control knob ti7 serves to shift thecontrol wire thereby swinging the dellector 78 toward or away from thetongue 77, the deector 79 being shown in a deflected position in FIGUREl0. The detlector 7S is shiftablc to any desired position between itstwo extreme positions depending upon the extent to which the controlknob 97 is rotated.

The housing 79 has an axially extending passageway 91 formed thereinwhich at one end communicates with the interior of the spiral members45, 46 and L17. At its opposite end, the passageway 91 communicates witha ared opening 92 formed in the proximal end wall of the housing 79. An0-ring 94 is seated in an annular recess formed in the Wall of theopening 92 to provide a seal when a exible obturator 95 or a flexiblelight and image-conducting assembly 190 is inserted into the sheath 75.A fitting 93, conveniently in the form of a Luer lock connector ismounted in the wall of the housing 79 and also communicates with thepassageway 91 for connecting the sheath to a source of oxygen.

The obturator 95 comprises an elongated flexible shaft 96 of suilicientdiameter at least at its proximal end to engage the O-ring 94 and sealthe opening 92 when the obturator is in position in the sheath 7S. Thelength of the shaft 96 is such that a smoothly rounded nose position 97mounted on its distal end extends through the tubular portion 77a andalong the tongue 77 at the distal tip of the sheath 75 to provide asmoothly rounded closure.

The composite light and image-conducting assembly 100 comprises anelongated flexible optical liber bundle 35 constructed in the samemanner as that described in connection with instrument llllr and havingan image-conducting group of fibers 36 surrounded by thelight-conducting group of bers 37. As is most clearly shown in FIGURE 9,the bundle 35 extends through an adapter 101 into a tubular member 102.Within the tubular member 102 the optical fibers forming thelight-conducting section 37 formed as a rod-like extension 37a extendthrough theside wall of the tubular member 102. The image-conductingoptical fiber section 36 is anchored centrally within the tubular member192 where an image on its end face 49 may be viewed through the eyepieceassembly 13.

The elongated flexible portion of the light and imageconducting assemblylill) is enclosed within a thin-walled flexible tube 103 which may bemade of latex or the like. The proximal end of the tube 193 is cementedto the adapter 191 while the distal end of the tube 103 is cemented to acover tube 104 which corresponds to the tube 5240i the instrument 10. v

The distal end of the light and image-conducting bundle 36 extends intothe tube 104. As shown and described in connection with FIGURE 3, thelens holder 57 is mounted on the end of the fiber bundle and serves -toseparate the end portions of the bers of the imageconducting group 36from the light-conducting group 37. Glass cylinder 60 provided withsilver coatings 61 extends in the space between the lens holder 57 andthe tube 104 with its annular proximal end face juxtaposed against thedistal end face 43 of the light-conducting group 37.

The cover tube 104 together with the lenses 59 and the other membersenclosed therein form an objective or viewing head 105 which extendsalong the tongue 77 and over the deector 78 when the light andimage-conducting assembly 100 is seated within the sheath 75. As shownin FIGURE 10, movement of the deflector 78 under the influence ofcontrol wire 90 serves to shift the viewing head 105 as desired througha relatively wide angle while the sheath itself is left undisturbed.When, by operation of the deflector, the head 105 is properly positionedto enter and pass along one of the smaller bronchi, the light andimage-conducting assembly 100 is inserted `farther into the sheath 75 soas to advance the viewing head assembly beyond the tongue 77 into thebronchus as deeply as may be required.

In carrying out a procedure with the instrument shown and described inconnection with FIGURES 6-11, the flexible obturator 95 is seated in theflexible sheath '75. The sheath 75 carrying the obturator 95 and withits fitting 93 connected to a source of oxygen is then introducedthrough the mouth of the patient preferably through an open shelflaryngoscope, such as a Lloyds, previously positioned by the surgeon.Shortly after introduction of the sheath, the oxygen supply is turned onand is fed to the lungs of the patient through the openings in thecollar 48. After introduction and while the distal ends of the sheathand obturator are still above the carina, the obturator may be removedand the light and image-conducting assembly 100 is inserted in its placewithin the sheath 75. Initially the assembly 10G is inserted only farenough so that the head assembly 105 rests on the retracted detlector78.

The field exposed to the viewing head 105 is illuminated as wasdescribed in connection with FIGURE l0, light from a suitable sourcebeing conducted by means of a flexible light conductor not shown to thelight-conducting group 37 from which it passes along the wall of theglass cylinder 60 and out of the distal end of the instrument.

With the distal ends of the sheath 75 and the light and image-conductingassembly 100 properly positioned, the instrument may be now readilyguided into either the left or right bronchus by suitable adjustment ofthe control knob 82 which serves to deflect the distal end portion ofthe instrument through operation of the control wires 28 and 29. Nowwhen it is desired, for example, to probe the right eparterial bronchus,the control knob 87 is operated to actuate the deflector 77. This servesto deflect the head 105 relative to the distal tip of the sheath 75 andthe assembly 100 may now be advanced along the sheath and into theeparterial bronchus.

'I'he terms and expressions which have been employed are used as termsof description and not of limitation, and there is no intention, in theuse of such terms and expressions of excluding any equivalents of thefeatures shown and described or portions thereof, but it is recognizedthat various modifications are possible within the scope of theinvention claimed.

I claim:

l. A flexible optical surgical instrument for insertion linto and forexamining the bronchi in the lungs of a patient, comprising an elongatedflexible sheath having at least one aperture through which oxygen isfree to pass intothe lungs of a patient, first resilent means extendingiongitudinally along said sheath from adjacent the proximal end of saidsheath over a predetermined portion thereof, second resilient meansextending longitudinally along said sheath from adjacent the distal endof said sheath to adjacent the distal end of said first resilient means,said first and second resilient means each being flexible with saidsecond resilient means being substantially more flexible than said firstresilient means, means for conducting an image of a field from thedistal to the proximal end of said sheath including an elongatedflexible bundle of a very large number of extremely fine lightconductingfibers extending longitudinally within said sheath and mutually orientedat the opposite end faces of said bundle so that an image presented tothe distal end of said bundle is conducted to the proximal end facethereof, means including control means adjacent to the proximal end ofsaid sheath for selectively deflecting the distal end of saidimage-conducting means, means at the proximal end of saidimage-conducting means for viewing an image formed on the proximal endface of said bundle, means including means extending longitudinallyalong said sheath for illuminating a field presented to the distal endof said image-conducting means, and means for feeding oxygen along saidsheath to said aperture.

2. A flexible optical surgical instrument for insertion into and forexamining the bronchi in the lungs of a patient, comprising an elongatedflexible sheath having at least one aperture through which oxygen isfree to pass into the lungs of a patient, first resilent means extendinglongitudinally along with said sheath from adjacent the proximal end ofsaid sheath over a predetermined portion thereof, second resilient meansextending longitudinally along said sheath from adjacent the distal endof said sheath to adjacent the distal end of said first resilient means,said first and second resilient means each being flexible with saidsecond resilient means being substantially more flexible than said firstresilient means, means for conducting an image of a field from thedistal to the proximal end of said sheath including an elongatedflexible bundle of a very large number of extremely finelight-conducting fibers extending longitudinally Within said sheath andmutually oriented at the opposite end faces of said bundle so that animage presented to the distal end of said bundle is conducted to theproximal end :face thereof, means adjacent to the proximal end of saidsheath and connected to the distal end thereof for selectivelydeflecting the distal ends of said sheath and said image-conductingmeans, means at the proximal end of said image-conducting means forviewing an image formed on the proximal end face of said bundle, meansincluding means extending longitudinally along said sheath forilluminating a field presented to the distal end of saidimage-conducting means, said image-conducting means extending out of thedistal end of said sheath, second deflecting means including controlmeans adjacent to the proximal end of said sheath for deflecting thedistal end portion of said illuminating and image-conducting meansrelative to the distal end of said sheath, and means for feeding oxygenthrough said sheath to said aperture.

3. A flexible optical surgical instrument for insertion into and forexamining the bronchi in t-he lungs of a patient, comprising anelongated flexible sheath having at least one aperture through whichoxygen is free to pass into the lungs of a patient, first resilientmeans extending longitudinally along said sheath from adjacent theproximal end of said sheath over a predetermined portion thereof, secondresilient means extending longitudinally along said sheath from adjacentthe distal end of said sheath to adjacent the distal end of said firstresilient means, said rst and second resilient means each being flexiblewith said second resilient means being substantially more flexible thansaid first resilient means, light and image-conducting means extendinglongitudinally through said sheath and comprising two groups of a verylarge number of extremely fine light-conducting bers with one group offibers being adapted to illuminate a field presented to the distal endof the other group of fibers and said other group of fibers beingadapted to conduct an image of said field from the distal to theproximal end thereof, means for connecting the proximal end of saidfirst group of fibers to a source of light, means adjacent to theproximal end of said sheath and connected to the distal end thereof forselectively deflecting the distal ends of said sheath and said light andimage-conducting means, said image-conducting means extending out of thedistal end of said sheath, means for viewing an image of said field onthe proximal end of said second group of fibers, and means for feedingoxygen along said sheath to said aperture.

.4. A flexible optical surgical instrument for insertion into and forexamining the bronchi in the lungs of a patient, comprising an elongatedflexible sheath having at least one aperture through which oxygen isfree to pass into the lungs of a patient, first resilient meansextending longitudinally along said sheath from adjacent the proximalend of said sheath over a predetermined portion thereof, secondresilient means extending longitudinally along said sheath from adjacentthe distal end of said sheath to adjacent the distal end of said firstresilient means, said first and second resilient means each beingflexible with said second resilient means being substantially moreflexible .than said first resilient means, light and image-conductingmeans extending longitudinally through said sheath and comprising twogroups of a very large number of extremely fine light-conducting fiberswith one group of fibers being adapted to illuminate a field presentedto the distal end of the other group of fibers and said other group offibers being adapted to conduct an image of said field from the distalto the proximal end thereof, means for connecting the proximal end ofsaid first group of fibers to a source of light, means adjacent to theproximal end of said sheath and connected to the distal end thereof forselectively deflecting the distal ends of said sheath and said light andimage-conducting means, said image-conducting ineans extending out ofthe distal end of said sheath, second deflecting means including controlmeans adjacent to the proximal end of said sheath for deflecting thedistal end portion of said illuminating and image-conducting meansrelative to the distal end of said sheath, means for viewing an image ofsaid field on the proximal end of Said second group of fibers, and meansfor feeding oxygen along said sheath to said aperture.

5. A flexible optical surgical instrument for inertion into and forexamining the bronchi in the lungs of a patient, comprising an elongatedflexible sheath forming a longitudinally extending passageway and havingat least one aperture communicating with said passageway for passingoxygen into the lungs of a patient, a housing connected to the proximalend of said sheath and having its interior in communication with saidpasageway, first resilient means connected to the distal end of saidhousing and extending longitudinally along said passageway in saidsheath over a major portion thereof, second resilient means extendinglongitudinally along said passageway and connected at its proximal endto the distal end of said first resilient means, the distal end of saidsecond resilient means being connected to the distal end of said sheath,said first and second resilient means being flexible with said secondresilient means being more flexible than Said rst resilient means,elongated flexible means connected to the distal end of said secondresilient means and extending along said passageway into said housing,means in said housing for actuating said flexible means to selectivelydeflect the distal end of said sheath, light and image-conducting meansextending through said sheath along said pasageway and into saidhousing, said light and image-conducting means including two groups of avery large number of extremely fine light-conducting fibers with onegroup of fibers being adapted to illuminante a field presented to thedistal end of the other group of fibers and said other group of fibersbeing adapted to conduct an image of said field from the distal to theproximal end thereof, means on said housing for connecting a source oflight to the proximal end of said first group of fibers, means connectedto said housing for viewing an image on the proximal end of said secondgroup of fibers, means connected to the distal end of said secondresilient means for forming an image of said field on the distal end ofsaid second group of fibers,

and means for connecting said housing to a supply of l oxygen.

6. A flexible optical surgical instrument for insertion into and forexamining the bronchi in the lungs of a patient, comprising first andsecond elongated flexible tubular members with said second tubularmember having a smaller diameter than said first tubular member, aconnector joining the distal and proximal ends of said first and secondtubular members and having an aperture formed therethrough communicatingwith the passageways of said tubular members for passing oxygen into thelungs of a patient, a housing connected to the proximal end of saidfirst tubular member and having its interior in cornmunication with thepassageway of said second tubular member through said first tubularmember, first resilient means comprising a plurality of spiral memberswound one within the other about a common axis, said first resilientmeans being connected to the distal end of said hous- Ving and extendinglongitudinally through said first tubular member and being connected atits distal end to one end of said connector, second resilient meanscomprising a plurality of spiral members wound one within the otheralong a common axis, said second resilient means being connected at itsproximal end to the other end of said connector and its distanl endbeing connected to the distal end of said second tubular member, saidsecond resilient means having a smaller diameter and being more flexiblethan said first resilient means, a pair of wire members connected toopposite sides of the distal end of said second resilient means andextending along said first and second tubular members into said housing,a pair of blocks movably mounted in said housing with each of saidblocks being connected to one of said wires, means on said housingconnected to said blocks for actuating said wire members and therebyselectively deflect the distal end portions of said second resilientmeans and second tubular member, elongated flexible light andimage-conducting means extending axially along said first and secondresilient means from the distal end thereof into said housing, saidlight and image-conducting means including two groups of a very largenumber of extremely fine lightconducting fibers with one group of fibersbeing adapted to illuminate a field presented to the distal end of theother group of fibers and said other group of `fibers being adapted toconduct an image of said field from the distal to the proximal endthereof, means on said housing for connecting a source of light to theproximal end of said' first group of fibers, means connected to saidhousing for viewing an image on the proximal end of said second group offibers, means connected to the distal end of said resilient means forforming an image of said field on the distal end of said group offibers, and means for connecting said housing to a supply of oxygen.

7. A flexible optical surgical instrument for insertion into and forexamining the bronchi in the lungs of a patient, comprising an elongatedflexible sheath having at least one aperture for passing oxygen into thelungs of a patient, elongated light and image-conducting means longerthan said sheath and adapted to be removably inserted in and movablelongitudinally along said sheath with the distal end thereof projectingfrom the distal end of said sheath, said light and image-conductingmeans being adapted for illuminating a field presented to the distal endthereof and for conducting an image of said field to the proximal endthereof, means for connecting the proximal end of said sheath to asupply of oxygen, and means including control means adjacent theproximal end of said sheath for deliecting the distal end portion ofsaid sheath and for detiecting the distal end portion of said light andimageconducting means relative to said sheath.

8. A flexible optical surgical instrument for insertion into and forexamining the bronchi in the lungs of a patient, comprising an elongatedflexible sheath having at least one aperture for passing oxygen into thelungs of a patient, elongated light and image-conducting means longerthan said sheath and adapted to be removably inserted in and movablelongitudinally along said sheath with the distal end thereof projectingfrom the distal end of said sheath, said light and image-conductingmeans being adapted for illuminating afield represented to the distalend thereof and for conducting an image of said field to the proximalend thereof, means for connecting the proximal end of said sheath to asupply of oxygen, shiftable means mounted on the distal end of saidsheath for limited displacement into engagement with the distal endportion of said light and image-conducting means for deflecting the samerelative to said sheath, and means including control means adjacent theproximal end of said sheath for deliecting the distal end of said sheathand for actuating said shiftable means to deflect said distal endportion of said light and image-conducting means relative to saidsheath.

9. A iiexible optical surgical instrument for insertion into and forexamining the bronchi in the lungs of a patient, comprising an elongatedflexible sheath having at least one aperture for passing oxygen into thelungs of a patient, first resilient means extending longitudinally alongwith said sheath from adjacent the proximal end of said sheath over apredetermined portion thereof, second resilient means extendinglongitudinally along said sheath from adjacent the distal end of saidsheath to adjacent the distal end of said first resilient means, saidfirst and second resilient means each being flexible with said secondresil- -ient means being substantially more flexible than said -firstresilient means, means removably mounted in and longitudinally movablerelative to said sheath for illuminating a field at the distal endthereof and for conducting an image of said field to the proximal endthereof including an elongated iiexible bundle of a very large number oflongitudinally extending extremely fine light-conducting fibers, meansadjacent to the proximal end of said sheath and connected to the distalend thereof for selectively defiecting the distal end of said sheath,means at the proximal end of said bundle for viewing an image formed onthe proximal end face thereof, a deliector mounted on the distal end ofsaid sheath for limited displacement into engagement with the distal endportion of said bundle, means adjacent to the proximal end of saidsheath connected to said defiector for defiecting the distal end portionof said bundle relative to the distal end of said sheath, and means forconnecting the proximal end of said sheath to a supply of oxygen. l 'jl0. A iiexible optical surgical instrument forl insertion into and forexamining the bronchi in the lungs of a patient, comprising first andsecond elongated flexible tubular members with said second tubularmember having a smaller diameter than said first tubular member, aconnector joining the distil end of said first tubular member 6 of apatient, a housing connected to the proximal end of said first tubularmember and having its interior in communication with the passageway ofsaid sheath, first resilient means comprising a plurality of spiralmembers wound one within the other about a common axis, said firstresilient means being connected to the distal end of said housing andextending longitudinally through said first tubular member and beingconnected at its distal end to one end of said connector, secondresilient means comprising a plurality of spiral members wound onewithin the other along a common axis, said second resilient -means beingconnected at its proximal end to the other end of said connector and itsdistal end being connected to the distal end of said second tubularmember, said second,resilient means having a smaller diameter and beingmore fiexible than said first resilient means, a

deflector hingedly connected to the distal end of said sheath, a pair ofwire members connected to opposite sides of the distal end of saidsecond resilient means and extending along said sheath into saidhousing, a pair of blocks movably mounted in said housing with each ofsaid blocks being connected to one of said Wires, means on said housingconnected to said blocks for actuating said wire members and therebyselectively deliect the distal end portions of said second resilientmeans and second tubular member, a third wire member connected to saiddefiector and extending along said sheath into said housing a thirdblock movably mounted in said housing and connected -to said third wire,said housing having an opening formed therein, elongated flexible lightand imageconducting means removably insertable through said housingopening into said sheath and longitudinally movable relative to saidsheath with the distal end thereof projecting from the distal end ofsaid sheath, means for sealing said opening while leaving said light andimage-conducting means free to move therethrough, said light andimage-conducting means including two groups of a very large number ofextremely fine light-conducting fibers with one group of fibers beingadapted to illuminate a field presented to the distal end of the othergroup of fibers and said other group of fibers being adapted to conductan image of said field from the distal to the proximal end thereof,means for connecting a source of light to the proximal end of said firstgroup of fibers, means connected to the proximal end of said light andimage-conducting means for viewing an image on the proximal end of saidsecond group of fibers, means adjacent to the distal end of said secondgroup of fibers for forming an image of said field on the distal end ofsaid second group of fibers, means on said housing connected to saidthird block for actuating said deector and thereby shift the distal endportion of said light and image-conducting means relative to the distalend of said sheath, and means for connecting said housing to a supply ofoxygen.

References Cited in the file of this patent UNITED STATES PATENTS FranceOct. 19, 1960 OTHER REFERENCES .n

Kapany article in the Strong Book, Concept of Classical Optics, 1958,pages 565-567, publishedby W. H. Freeman and Co. Ine. (Copy in Div. 7,88-1 (LC R).)

1. A FLEXIBLE OPTICAL SURGICAL INSTRUMENT FOR INSERTION INTO AND FOREXAMINING THE BRONCHI IN THE LUNGS OF A PATIENT, COMPRISING AN ELONGATEDFLEXIBLE SHEATH HAVING AT LEAST ONE APERTURE THROUGH WHICH OXYGEN ISFREE TO PASS INTO THE LUNGS OF A PATIENT, FIRST RESILENT MEANS EXTENDINGLONGITUDINALLY ALONG SAID SHEATH FROM ADJACENT THE PROXIMAL END OF SAIDSHEATH OVER A PREDETERMINED PORTION THEREOF, SECOND RESILIENT MEANSEXTENDING LONGITUDINALLY ALONG SAID SHEATH FROM ADJACENT THE DISTAL ENDOF SAID SHEATH TO ADJACENT THE DISTAL END OF SAID FIRST RESILIENT MEANS,SAID FIRST AND SECOND RESILIENT MEANS EACH BEING FLEXIBLE WITH SAIDSECOND RESILIENT MEANS BEING SUBSTANTIALLY MORE FLEXIBLE THAN SAID FIRSTRESILIENT MEANS, MEANS FOR CONDUCTING AN IMAGE OF A FIELD FROM THEDISTAL TO THE PROXIMAL END OF SAID SHEATH INCLUDING AN ELONGATEDFLEXIBLE BUNDLE OF A VERY LARGE NUMBER OF EXTREMELY FINE LIGHTCONDUCTINGFIBERS EXTENDING LONGITUDINALLY WITHIN SAID SHEATH AND MUTUALLY ORIENTEDAT THE OPPOSITE END FACES OF SAID BUNDLE SO THAT AN IMAGE PRESENTED TOTHE DISTAL END OF SAID BUNDLE IS CONDUCTED TO THE PROXIMAL END FACETHEREOF, MEANS INCLUDING CONTROL MEANS ADJACENT TO THE PROXIMAL END OFSAID SHEATH FOR SELECTIVELY DEFLECTING THE DISTAL END OF SAIDIMAGE-CONDUCTING MEANS, MEANS AT THE PROXIMAL END OF SAIDIMAGE-CONDUCTING MEANS FOR VIEWING AN IMAGE FORMED ON THE PROXIMAL ENDFACE OF SAID BUNDLE, MEANS INCLUDING MEANS EXTENDING LONGITUDINALLYALONG SAID SHEATH FOR ILLUMINATING A FIELD PRESENTED TO THE DISTAL ENDOF SAID IMAGE-CONDUCTING MEANS, AND MEANS FOR FEEDING OXYGEN ALONG SAIDSHEATH TO SAID APERTURE.